The Caribbean depends on visitor arrivals more than any other region in the world, with over 55M visitors in 2019 (CTO 2020). Tourism is a priority, as it has one of the highest development impacts in the Caribbean. It is the principle contributor to income, employment, foreign exchange and economic growth. Enhancing sustainable tourism is essential for promoting economic development, poverty eradication and improvement of quality of life in small islands developing tourism dependant states like th Caribbean region.
High and increasing numbers of visitors to Caribbean region increase the health, safety and security risks to local populations. Travel/tourism-related illnesses are not only a health and security risk but contribute to reputational damage and economic instability in Caribbean economies This is evident through the introduction and spread of new and re-emerging diseases by visitor populations, such as SARs, H1NI, Chikungunya, Zika, Norovirus, Measles and now, the novel coronavirus (COVID-19) pandemic. From 2010-2016, 255 outbreaks of gastroenteritis (GI) were reported to CARPHA, of which 33% were travel related. One outbreak in 2012 caused over 1200 illnesses, closure of hotels, travel advisories and a 30% decline in arrivals to that country. This outbreak could have been significantly reduced if it had been detected and reported earlier. Another in 2018 affected 300 persons. A new strain (of which pathogen) originating in Australia, is already reported in MS. In 2017, the number of measles cases occurring in Europe was four times that of 2016. Since the Caribbean has been certified free of polio, measles and rubella, just one confirmed indigenous case of any of these diseases would be considered an outbreak. The health of Caribbean economies is thus closely related to the infectious health of its travel and tourism industry given that the Caribbean is the most tourism-dependent region in the world.
The Caribbean eliminated vaccine-preventable diseases of measles, polo and rubella, but unlike smallpox, they have not been eradicated from the world. International travel and tourism put the Caribbean at great danger for these diseases and creates a real risk of them once again gaining a foothold in the countries. The Caribbean receives visitors and immigrants from all over the world; many coming from countries where measles and rubella are everyday occurrences and the countries involvement in global sports, religious and trade events, increases the risk of possible transmission from one person to another. Travelers can move from one continent to another in under 24 hours and be carrying viruses unknown to them and can transmit disease from one country to the next. With the ever-increasing vaccine hesitancy and the resulting decline in coverage for vaccines throughout the world, outbreaks of measles, rubella, diphtheria, whooping cough and other vaccine-preventable diseases are on the rise. In 2017, the number of measles cases occurring in Europe was four times that of 2016. Measles continues to thrive in all other continents of the world. Since the Caribbean has been certified free of polio, measles and rubella, just one confirmed case of any of these diseases would be considered an outbreak.
However, even though more people visit the Caribbean than reside, current health monitoring surveillance systems are primarily based on the local population, and there is no ongoing visitor tourism-based surveillance and response system. There is also inadequate food and environmental sanitation training for the tourism sector, lack of cumulative HSE standards and certifying system and a marked lack of integration between tourism and health stakeholders to address health in tourism in the Caribbean region. These gaps have all contributed to the spread of disease outbreaks, food safety and environmental sanitation issues in the region; and without adequate information management systems, standards and training, these HSE threats can become a severe tourism crisis. These risks and the importance of the tourism industry on the Caribbean region highlight the need for a system to monitor both traveller’s and resident’s health, provide rapid dissemination of real-time information and respond quickly to prevent and control outbreaks.
Given the large number of visitors to the Region, and the demonstrated health safety and security risks associated with travel, there is a clear and critical need for Caribbean countries to expand their national surveillance systems to capture all aspects of the population, both permanent and transient (visitors) for more adequate disease detection leading to prevention and control as part of their core public health obligation. International health surveillance systems for travel/tourism, food safety training and standards implemented by public health agencies in the US, UK and Canada can reduce the spread and number of illness outbreaks, and improved food safety and environmental sanitation.
The introduction and spread of COVID -19 and other new and emerging diseases in Caribbean (i.e. Norovirus, Chikungunya virus, Zika virus ans ) exemplify the need for surveillance systems that capture all aspects of the population, both permanent and transient (visitors) There is thus a clear and critical necessity for Caribbean countries to expand their national surveillance systems to capture travel related/ visitor/tourism illnesses for more adequate disease detection and prevention and control as part of their core public health obligation.).
A key element of increasing capacity for disease prevention and control is core surveillance systems that can detect public health issues in real-time and providing information that allows for a timely, efficient and coordinated response. The International Health Regulations 2005 (IHR 2005) also binds countries to “prevent the international spread of disease”. Inadequate health monitoring/response systems have contributed to the spread of disease outbreaks. Travelers Health surveillance systems implemented by public health agencies in the US, UK and Canada have shown to be effective in detecting and reducing the spread of illness outbreaks.
It is within this context that CARPHA established a Regional Tourism and Health Program in 2014, with funding received from the International Development Bank in 2016 to execute.